Peritoneal dialysis as initial dialysis modality: a viable option for late-presenting end-stage renal disease

Introduction Low serum albumin is associated with high mortality in patients with end-stage renal disease (ESRD) on chronic dialysis. Clinicians are reluctant to offer peritoneal dialysis (PD) as an option for dialysis for patients with low serum albumin due to concerns of loss of albumin with PD, but evidence supporting differences in outcomes is limited. We evaluated mortality based on dialysis modality in patients with very low serum albumin (< 2.5 g/dL). Methods We analyzed United States Renal Data System (USRDS) data from 2010 to 2015 to assess mortality by modality adjusted for age, sex, race, employment, number of comorbidities, and year of dialysis initiation. Results Low serum albumin (< 2.5 g/dL) was present in 78,625 (19.9%) of 395,656 patients with ESRD on chronic dialysis. Patients with low serum albumin were less likely to use PD as their first modality than those with higher albumin (3.1% vs 10.9%; p < 0.001). Use of PD was associated with lower mortality compared with hemodialysis (HD) (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.81 – 0.95, p < 0.05) in patients with low serum albumin. This difference was more pronounced in patients who had glomerulonephritis (HR = 0.72) or hypertension (HR = 0.81) than in those with end-stage renal disease (ESRD) due to diabetes mellitus or other causes. Conclusion Peritoneal dialysis is less likely to be the first dialysis modality in patients with low serum albumin requiring dialysis. However, PD is associated with lower mortality than HD in patients with low serum albumin on dialysis. We recommend advocating the use of PD in patients with low serum albumin.

Download Full-text

Patient Survival Between Hemodialysis and Peritoneal Dialysis Among End-Stage Renal Disease Patients Secondary to Myeloperoxidase-ANCA-Associated Vasculitis

Frontiers in Medicine ◽

10.3389/fmed.2021.775586 ◽

2022 ◽

Vol 8 ◽

Author(s):

Xueqin Wu ◽

Yong Zhong ◽

Ting Meng ◽

Joshua Daniel Ooi ◽

Peter J. Eggenhuizen ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Patient Survival ◽

Dialysis Initiation ◽

Dialysis Modality ◽

Significant Difference ◽

Stage Renal Disease ◽

End Stage

BackgroundA significant proportion of anti-neutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis eventually progresses to end-stage renal disease (ESRD) thus requiring long-term dialysis. There is no consensus about which dialysis modality is more recommended for those patients with associated vasculitis (AAV-ESRD). The primary objective of this study was to compare patient survival in patients with AAV-ESRD treated with hemodialysis (HD) or peritoneal dialysis (PD).MethodsThis double-center retrospective cohort study included dialysis-dependent patients who were treated with HD or PD. Clinical data were collected under standard format. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity at diagnosis and organ damage was assessed using the vasculitis damage index (VDI) at dialysis initiation.ResultsIn total, 85 patients were included: 64 with hemodialysis and 21 with peritoneal dialysis. The patients with AAV-PD were much younger than the AAV-HD patients (48 vs. 62, P < 0.01) and more were female (76.2 vs. 51.6%, P = 0.05). The laboratory data were almost similar. The comorbidities, VDI score, and immuno-suppressive therapy at dialysis initiation were almost no statistical difference. Patient survival rates between HD and PD at 1 year were 65.3 vs. 90% (P = 0.062), 3 year were 59.6 vs. 90% (P < 0.001), and 5 years were 59.6 vs. 67.5% (P = 0.569). The overall survival was no significant difference between the two groups (P = 0.086) and the dialysis modality (HD or PD) was not shown to be an independent predictor for all-cause death (hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.31–1.7; P = 0.473). Cardio-cerebrovascular events were the main cause of death among AAV-HD patients while infection in patients with AAV-PD.ConclusionThese results provide real-world data that the use of either hemodialysis or peritoneal dialysis modality does not affect patient survival for patients with AAV-ESRD who need long-term dialysis.

Download Full-text

Effect of dialysis modality on the survival of end-stage renal disease patients starting dialysis in Sabah from 2007 to 2017: a retrospective cohort study

10.1101/2021.07.26.21261164 ◽

2021 ◽

Author(s):

Thamron Keowmani ◽

Anis Kausar Ghazali ◽

Najib Majdi Yaacob ◽

Koh Wei Wong

Keyword(s):

Cohort Study ◽

Peritoneal Dialysis ◽

Confidence Interval ◽

Renal Disease ◽

End Stage Renal Disease ◽

Retrospective Cohort ◽

Dialysis Modality ◽

Stage Renal Disease ◽

End Stage

Background: The effect of dialysis modality on the survival of end-stage renal disease patients is a major public health interest. Methods: In this retrospective cohort study, all adult end-stage renal disease patients receiving dialysis treatment in Sabah between January 1, 2007 and December 31, 2017 as identified from the Malaysian Dialysis and Transplant Registry were evaluated and followed up through December 31, 2018. The endpoint was all-cause mortality. The observation time was defined as the time from the date of dialysis initiation after the onset of end-stage renal disease to whichever of the following that came first: date of death, date of transplantation, date of last follow-up, date of recovered kidney function, or December 31, 2018. Weighted Cox regression was used to estimate the effect of dialysis modality. Analyses were restricted to patients with complete data on all variables. Results: 1,837 patients began hemodialysis and 156 patients started with peritoneal dialysis, yielding 7,548.10 (potential median 5.48 years/person) and 747.98 (potential median 5.68 years/person) person-years of observation. 3.1% of patients were lost to follow-up. The median survival time was 5.8 years (95% confidence interval: 5.4, 6.3) among patients who started on hemodialysis and 7.0 years (95% confidence interval: 5.9, indeterminate) among those who started on peritoneal dialysis. The effect of dialysis modality was not significant after controlling for confounders. The average hazard ratio was 0.80 (95% confidence interval: 0.61, 1.05) with hemodialysis as a reference. Conclusion: There was no evidence of a difference in mortality between hemodialysis and peritoneal dialysis.

Download Full-text

Gender differences in peritoneal dialysis initiation in the US end-stage renal disease population

Peritoneal Dialysis International ◽

10.1177/0896860819878656 ◽

2020 ◽

Vol 40 (1) ◽

pp. 57-61

Author(s):

Savannah L Vogel ◽

Tripti Singh ◽

Brad C Astor ◽

Sana Waheed

Keyword(s):

United States ◽

Gender Differences ◽

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

The United States ◽

Mean Value ◽

Dialysis Modality ◽

Stage Renal Disease ◽

End Stage

Background: Overall, a disproportionately small number of end-stage renal disease (ESRD) patients start peritoneal dialysis (PD) in the United States compared to hemodialysis. Little is known about whether gender has an effect on the initial modality of renal replacement therapy utilized by patients; however, prior studies have demonstrated gender disparities in the diagnosis and treatment of various other health conditions, including kidney disease. Methods: Using data from the United States Renal Data System (USRDS), we estimated the proportion of patients utilizing PD as their initial dialysis modality between 2000 and 2014, adjusting estimates to the mean value of all covariates and compared these estimates for women and men. Results: We found that 7.9% of women and 7.5% of men used PD as their initial dialysis modality. The unadjusted odds ratio (OR) of women initiating PD as their initial modality compared to men was 1.04 (95% CI 1.02–1.05, p < 0.001). After adjustment for age, race, ethnicity, cause of ESRD, number of comorbidities, income, employment status, and timing of referral to nephrology, the difference was even more significant, with women being 12% (OR 1.12, CI 1.10–1.14, p < 0.001) more likely to initiate PD than men. However, within different subgroups, older women and women with higher number of comorbidities were less likely to be on PD than their male counterparts. Conclusions: Our results indicate that gender plays a role in the initial dialysis modality used by patients and providers should be cognizant of these gender differences. Further studies are needed to ascertain the cause of this observed difference.

Download Full-text

Feasibility of Urgent-Start Peritoneal Dialysis in Older Patients with End-Stage Renal Disease: A Single-Center Experience

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00002 ◽

2017 ◽

Vol 38 (2) ◽

pp. 125-130 ◽

Cited By ~ 9

Author(s):

Haijiao Jin ◽

Zhaohui Ni ◽

Shan Mou ◽

Renhua Lu ◽

Wei Fang ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Older Patients ◽

Catheter Insertion ◽

Dialysis Modality ◽

Single Center ◽

Short Term ◽

Stage Renal Disease ◽

End Stage

Background Patients with end-stage renal disease (ESRD) frequently require urgent-start dialysis. Recent evidence suggests that peritoneal dialysis (PD) might be a feasible alternative to hemodialysis (HD) in these patients, including in older patients. Methods This retrospective study enrolled patients aged > 65 years with ESRD who underwent urgent dialysis without functional vascular access or PD catheter at a single center, from January 2011 to December 2014. Patients were grouped based on their dialysis modality (PD or HD). Patients unable to tolerate PD catheter insertion or wait for PD were excluded. Each patient was followed for at least 30 days after catheter insertion. Short-term (30-day) dialysis-related complications and patient survival were compared between the 2 groups. Results A total of 94 patients were enrolled, including 53 (56.4%) who underwent PD. The incidence of dialysis-related complications during the first 30 days was significantly lower in PD compared with HD patients (3 [5.7%] vs 10 [24.4%], p = 0.009). Logistic regression identified urgent-start HD as an independent risk factor for dialysis-related complications compared with urgent-start PD (odds ratio 4.760 [1.183 – 19.147], p = 0.028). The 6-, 12-, 24-, and 36-month survival rates in the PD and HD groups were 92.3% vs 94.6%, 82.4% vs 81.3%, 75.7% vs 74.2%, and 69.5% vs 60.6%, respectively, with no significant differences between the groups (log-rank = 0.011, p = 0.915). Conclusion Urgent-start PD was associated with fewer short-term dialysis-related complications and similar survival to urgent-start HD in older patients with ESRD. Peritoneal dialysis may thus be a safe and effective dialysis modality for older ESRD patients requiring urgent dialysis.

Download Full-text

Peritoneal Dialysis in Patients with Diabetes: Are the Benefits Greater than the Disadvantages?

Peritoneal Dialysis International ◽

10.1177/089686080702702s33 ◽

2007 ◽

Vol 27 (2_suppl) ◽

pp. 190-195 ◽

Cited By ~ 1

Author(s):

Satoru Kuriyama

Keyword(s):

Diabetic Nephropathy ◽

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Diabetic Patients ◽

Dialysis Modality ◽

Patients With Diabetes ◽

Stage Renal Disease ◽

End Stage ◽

Selection Of

Diabetic nephropathy has been increasing in prevalence in recent years, and it is now the dominant cause of end-stage renal disease (ESRD) worldwide. Because diabetes is frequently associated with multiple complications, nephrologists must be alert to the selection of dialysis modality so as to reduce the accompanying risks. The present review addresses whether the benefits of peritoneal dialysis are greater than its disadvantages in diabetic patients. The answer is quite positive: for most diabetic patients, peritoneal dialysis offers multiple benefits.

Download Full-text

In-Hospital Mortality in Cirrhotic Patients with End-Stage Renal Disease Treated with Hemodialysis versus Peritoneal Dialysis: A Nationwide Study

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00131 ◽

2017 ◽

Vol 37 (4) ◽

pp. 464-471 ◽

Cited By ~ 3

Author(s):

Mark A. Nader ◽

Rodrigo Aguilar ◽

Prabin Sharma ◽

Parasuram Krishnamoorthy ◽

Dragoi Serban ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Disease ◽

Hospital Mortality ◽

Subgroup Analysis ◽

End Stage Renal Disease ◽

Hospital Charges ◽

Dialysis Modality ◽

Cirrhotic Patients ◽

Stage Renal Disease ◽

End Stage

BackgroundCirrhotic patients often develop end-stage renal disease (ESRD) requiring renal replacement therapy in the form of hemodialysis (HD) or peritoneal dialysis (PD). Studies comparing the outcomes and difference in in-hospital mortality between these 2 groups, particularly among those with ascites, are sparse. We set our objective to determine the dialysis modality with a better in-hospital survival rate among cirrhotic patients with ESRD (ESRD-cirrhosis).MethodsData was extracted from the 2005 to 2012 Nationwide Inpatient Sample (NIS). Using propensity score matching, ESRD-cirrhosis patients on PD were matched with patients on HD at a 1:1 ratio. Another subgroup analysis of ESRD-cirrhosis patients with ascites was performed using the same matching algorithm. Analyses were performed using SAS version 9.3 (SAS Institute, Cary, NC, USA).ResultsAmong 26,135 cirrhotic patients with incident ESRD, 25,686 (98.3%) and 449 (1.7%) were initiated on HD and PD, respectively, during the hospitalization. There was a nonsignificant mortality difference between the ESRD-cirrhosis patients treated with PD and those treated with HD. In a subgroup analysis of these patients with ascites, 18 patients underwent PD while 1,878 patients required HD. Also, PD had a significantly lower in-hospital mortality compared with HD in this subgroup (0% vs 26.67%, p = 0.03). Mean length of stay for those who received HD was 8.34 days compared with 7.06 days for the PD group ( p < 0.0001). Similarly, mean hospital charges were greater for those who had HD compared with PD ($74,501 vs $57,460; p < 0.001).ConclusionCirrhotic patients with ESRD and ascites who undergo PD have a significantly lower mortality than those who are started on HD. However PD is rarely initiated for ESRD in cirrhotic patients with ascites during hospitalization in the United States. Due to the potential advantages of PD, nephrologists should encourage PD when selecting dialysis modality in this subgroup of patients whenever possible.

Download Full-text

A Qualitative Assessment of Mismatch between Dialysis Modality Selection and Initiation

Peritoneal Dialysis International ◽

10.3747/pdi.2015.00047 ◽

2016 ◽

Vol 36 (4) ◽

pp. 463-466 ◽

Cited By ~ 5

Author(s):

Susan Ziolkowski ◽

Scott Liebman

Keyword(s):

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Renal Disease ◽

Replacement Therapy ◽

End Stage Renal Disease ◽

Qualitative Assessment ◽

Dialysis Modality ◽

Home Dialysis ◽

Stage Renal Disease ◽

End Stage

At our institution, we have noted that end-stage renal disease patients choosing a home dialysis modality after education often initiate renal replacement therapy with in-center hemodialysis (HD) instead. We interviewed 24 such patients (23 choosing peritoneal dialysis [PD], one choosing home HD) to determine reasons for this mismatch. The most common reasons cited for not starting home dialysis were: lack of confidence/concerns about complications, lack of space or home-related issues, a feeling of insufficient education, and perceived medical or social contraindications. We propose several potential strategies to help patients start with their preferred modality.

Download Full-text